Promoting the female condom to refugees

UNHCR and its partners have been providing male condoms since the late 1990s. However, uptake remains alarmingly low. Will the agency be more successful in promoting the female condom, a female-initiated barrier method of contraception and disease prevention?

The public health rationale for condom use in the refugee setting is compelling, as refugees are particularly vulnerable to HIV and sexually transmitted infections (STIs). Social dislocation, economic deprivation, increased sexual violence, lack of access to medical services, increased transactional sex and increased contact with potentially infected populations put refugees, especially women, at heightened risk.

The female condom is a loose-fitting polyurethane sheath. It has an inner ring, which is inserted into the vagina and keeps the condom in place, and an outer ring, which remains on the outside of the body. Inserting the device correctly takes some practice. The female condom is currently the only available form of woman-initiated protection against HIV. Produced in the UK, it is about ten times more expensive than the male condom. It is marketed for single-use only, but the World Health Organisation has outlined a cleaning procedure for re-use (up to five times) for cases where resources are limited and no other alternatives for sexual protection are available.

In order to promote the female condom more successfully, experiences were reviewed in thirteen country programmes, and interviews and workshops were conducted with refugees and NGO staff in Kakuma refugee camp, Kenya.

Most NGO staff and refugees have never seen a female condom. In Kakuma initial reactions varied from enthusiasm, surprise and awe, to scepticism and fear. There is still much distrust and stigma associated with condoms. Stories of women dying because of male condoms lodged inside their vaginas, of men piercing the tip of condoms, of condoms breaking and of Western plots to lace condoms with HIV are common. There are wide gaps in basic knowledge on HIV/AIDS transmission (“if a man eats a lion with HIV, will he get HIV?”), adolescent development (“how will a young woman’s body develop if she doesn’t come in contact with men’s protein in semen?”) and reproductive anatomy (“won’t the female condom disappear inside the woman’s body?”). Unequal gender dynamics and traditional cultural practices prevent many women from introducing the female condom into their relationships. Many women expressed fear and discomfort at the idea of having to insert it. Previous experience with insertive devices such as tampons, diaphragms or cervical caps is limited and self-touching of genitalia is taboo in many cultures.

It is important to:

make female condoms available through health-related, as well as non-health-related outlets

share experiences among field staff to develop good practice which can also be used to inform the provision of future other female-controlled technologies, such as microbicides.[1]

Jacqueline Papo, a former UNHCR Research Intern, is a doctoral student at Oxford University’s Department of Public Health. Email: jacqueline.papo@stx.ox.ac.uk. To obtain a copy of UNHCR’s Female Condom Strategy, email hivaids@unhcr.ch

Book traversal links for Promoting the female condom to refugees

Disclaimer
Opinions in FMR do not necessarily reflect the views of the Editors, the Refugee Studies Centre or the University of Oxford.CopyrightFMR is an Open Access publication. Users are free to read, download, copy, distribute, print or link to the full texts of articles published in FMR and on the FMR website, as long as the use is for non-commercial purposes and the author and FMR are attributed. Unless otherwise indicated, all articles published in FMR in print and online, and FMR itself, are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs (CC BY-NC-ND) licence. Details at www.fmreview.org/copyright.